Healthcare Provider Details

I. General information

NPI: 1174889315
Provider Name (Legal Business Name): CARLOS R BENITEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE MOUNT SINAI HOSPITAL ONE GUSTAVE L. LEVY PLACE, BOX 1228
NEW YORK NY
10029
US

IV. Provider business mailing address

ONE GUSTAVE L. LEVY PLACE BOX 1228
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: